Hospitals Have Improved Capacity to Respond to Mass Casualty Events Since 2004

The COVID-19 pandemic has put pressure on hospitals and health systems throughout the United States and highlighted the need for medical surge preparedness.

In a new study published in the Journal of Healthcare Management, researchers applied the Hospital Medical Surge Preparedness Index (HMSPI) methodology to measure surge capacity in U.S. hospitals. The goal was to quantify hospitals’ ability to respond to mass casualty events.

“As an individual’s health depends on access to and delivery of quality healthcare, mass casualty emergencies require a hospital to ‘medically surge’ to save lives,” the authors explained.

After the 9/11 attacks, there was an increase in federal investments for disaster preparedness, but health systems continue to struggle in this area, they added. Understanding which hospitals can respond to an influx of patients is crucial for response planning and saving lives.

The researchers used 2005 to 2014 data from the American Hospital Association on 6,239 hospitals (3,123 had 82 or fewer beds), as well as data from the Dartmouth Atlas Project. HMSPI is a theoretical framework that reviews 4 metrics of surge capacity: staff, supplies, space, and systems.

Over the course of the study period, there was a steady increase in HMSPI scores. From 2005 to 2014, Montana had the largest increase in scores, followed by Kansas; Nevada had the smallest increase. Just looking at 2013 to 2014, many states had little or no differences, but North Dakota had the greatest increase, and Maine and Arkansas had the greatest decreases.

“From the analysis, and as might be expected, larger hospitals (those with more than 82 beds) had significantly higher surge capacity in terms of the space metric,” the authors noted.

They also reviewed the effect the Affordable Care Act (ACA) might have had on HMSPI scores; however, they did not find any statistically significant difference in scores between the year prior to ACA implementation and after ACA implementation.

There are a number of limitations that the authors highlighted. For instance, since the HMSPI has yet to be validated in relation to hospital performance during actual disasters, it cannot estimate access to care or outcomes. In addition, data until 2014 was analyzed, which only provides one year after the ACA was implemented, and more years of data may provide different results.

They wrote that future studies are needed to refine the score, assess the validity of the index, and evaluate its performance to disasters and policy changes.

“In the future, the HMSPI could serve as an objective and standardized measurement to assess the ability of hospitals, counties, and states to manage public health emergencies, such as the current coronavirus pandemic, and improve planning for mass casualty medical surges,” the authors concluded.